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Transferred from the contents of Dr. Xiaohe App's notes
【Basic information】Male, 12 years old
【Disease type】Tics
【Treatment Hospital】Harbin First Hospital (Top 3)
【Treatment plan】Medication
【Treatment period】One month of hospitalization, two months of continuous treatment after discharge
【Therapeutic effect】Symptoms are relieved and the condition is stable
First, the first acquaintance with the patient
In April 2019, the patient received at the outpatient clinic, the child was 12 years old, and when he saw the patient, he could see the patient's head swinging, but it was irregular. So I first asked the patient's mother about the child, the mother said that 3 months ago the child suddenly appeared head swing, talking a lot, all without warning and without reason, me and his father felt that it was sick, just come to see. In order to have a clearer picture of the condition, a systematic examination is required.
Second, the patient's treatment process
According to the symptoms and manifestations of the patient, combined with the patient's examination results in other hospitals have not appeared any abnormalities, we conduct basic health tests, mainly for the muscle and bone development of the head and neck, and the examination prompts the patient to have normal muscle tone, normal bone development, and no abnormalities in the nervous system examination. Psychiatric examination indicates that the patient has increased language, foul language, a certain degree of language disorder, and difficulty concentrating. EcG examination indicates normal with no abnormal fluctuations. Transenceal CT examination suggests normal, and no intracranial mass lesions are seen. According to the clinical symptoms of the patient, combined with relevant auxiliary tests, the diagnosis of tics is more likely.
Based on the diagnosis results, we developed a treatment plan for the patient, mainly drug therapy combined with psychotherapy. Drug therapy gives patients oral receptor agonist drugs, clonidine 0.05mg, once a day, taken before bedtime, combined with psychotherapy, we first let the parents of children understand the nature and characteristics of the disease, know that the tics are diseases rather than the child's naughty mischief, first get the support and cooperation of the family, and then correctly educate and patiently help the child, and then we will reasonably arrange the child's daily schedule and activity content, avoid excessive tension and fatigue, and carry out physical activity exercise. After the child was admitted to the hospital for 1 week, the sleep was better and the mood was better; after 2 weeks of admission to the hospital, the symptoms of observing the patient's head swing also improved; after 3 weeks of admission to the hospital, the symptoms of the patient's head swing were significantly alleviated, the mental state was good, and the personality became more active. After 4 weeks of hospitalization, the patient no longer had a head swing, and many of them had returned to normal. Notify the child's family to handle discharge, instruct the patient to take the medicine according to the doctor's instructions after discharge, pay attention to rest, do a good job of regular review, and if there is any discomfort during the medication, you can go to the outpatient clinic at any time.
Third, the patient's precautions in treatment
1. During the treatment, the family should create a warm environment for the patient, and do not let the child feel nervous and anxious during the treatment.
2. During the treatment period, we must follow the doctor's instructions, do not increase or decrease the amount of drugs, stop the drug, change the dressing, etc., and do a good job of regular review in the later stage.
3. During the treatment, the patient's family should closely observe the patient's clinical symptoms, and if there is an abnormality, it is necessary to communicate with the doctor in time.
Fourth, the patient's treatment effect
After the patient was treated, the condition was well controlled, the symptoms that appeared when admitted to the hospital basically disappeared, the phenomenon of inattention was improved, normal communication could be achieved, the symptoms were basically effectively controlled, and the child's mental state was good, more lively and agile. After going home for maintenance treatment for 2 months, the hospital re-examined, the examination results are basically no abnormality, tell the family that the drug can be temporarily stopped for observation, usually let the child relax, and the learning pressure should not be too much.
V. Precautions for patients in their daily lives
1. In daily life, we must pay attention to avoid being frightened, avoid staying up late, and ensure adequate sleep and rest.
2. In daily life, when educating children, parents must avoid scolding children, and communicate with children more.
3. In life, you need to pay attention to weather changes, prevent colds, prevent infections, improve immunity, and avoid triggering recurrence of the disease.
Sixth, the doctor's understanding
Tics is currently a mental illness with a relatively high incidence in the adolescent group, many patients' families because of the lack of comprehensive understanding of tic disorders, so when the child's initial symptoms miss the best time to receive formal examination and timely treatment, it will lead to a trend of development. Just like the small patient in this case, it has been three months since the symptoms of tics appeared, and the patient's family initially put the direction of treatment on the physical health examination, and did not take into account the mental illness, when I first contacted the patient, I obviously felt that the patient's mental state was abnormal, the mood was not high, and the language was urgent. Later, during the treatment, I also talked to the family about this kind of disease, or some content about the child's situation, and the family understood it in order to cooperate with the child to receive and complete the entire treatment, because only drug treatment is only part of the treatment, and psychological treatment is actually more important. It is recommended that everyone usually know more about mental illness, and when the family and friends around them have symptoms, they can make a preliminary judgment at the first time and choose to seek medical treatment in time.
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